Dyspepsia is a common symptom with an extensive differential diagnosis and a heterogeneous pathophysiology. It occurs in approximately 25 percent of the population each year, but most affected people do not seek medical care.

Approximately 25 percent of patients with dyspepsia have an underlying organic cause. However, up to 75 percent of patients have functional (idiopathic or nonulcer) dyspepsia with no underlying cause identified during diagnostic evaluation.

This topic review will provide an overview of the pathophysiology and treatment of functional dyspepsia. The definition, etiology, and general approach to the evaluation and management of the patient with dyspepsia are presented separately. (See "Approach to the adult with dyspepsia".)

The recommendations for the management of functional dyspepsia are largely consistent with the American Gastroenterological Association guidelines [1].

DEFINITION

According to the Rome III criteria, functional dyspepsia is defined as the presence of one or more of the following: postprandial fullness, early satiation, epigastric pain or burning and no evidence of structural disease (including at upper endoscopy) to explain the symptoms [2]. While patients with these symptoms and a negative diagnostic evaluation likely have functional dyspepsia, according to the Rome III guidelines, the criteria should be fulfilled for the last three months with symptom onset at least six months before diagnosis.

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